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   Table of Contents - Current issue
July-September 2020
Volume 28 | Issue 3
Page Nos. 133-198

Online since Tuesday, May 26, 2020

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The impact of Covid-19 pandemic on plastic reconstructive and aesthetic surgery practice p. 133
Cenk Demirdover
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The use of free helical rim flaps for the reconstruction of the ala nasi and lower eyelid p. 135
Zulfikar Ulas Bali, Alper Aksoy, Levent Yoleri
Aims and Objectives: The aim of this study was to present our experience using free flaps harvested from the helix in the reconstruction of the nose and lower eyelid. Materials and Methods: Between 2016 and 2019, 5 male and 2 female patients treated surgically with free helical flaps were included in the study. All defects had occurred due to tumor excision. Results: A total of two lower eyelid defects and five ala nasi defects were reconstructed using free helical rim flaps. Seven helical flaps based on the superficial temporal vessels were obtained and used for reconstruction. No recurrence was detected in any of the patients within the followup period. The only remarkable complication reported was dehiscence development, which was attributed to partial venous congestion in one patient. Free helical rim flaps are similar to the ala nasi and lower eyelids in terms of concave shape, tissue, and color. Conclusion: The results have shown that free helical rim flaps are a suitable option for use in the repair of appropriately sized fullthickness defects of the ala nasi and lower eyelid.
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Our experiences on microsurgical anastomosis of hepatic arteries, without thrombosis, in living donor liver transplantations p. 140
Ensar Zafer Barin, Onder Tan, Hakan Cinal, Murat Kara, Gurkan Ozturk, Bulent Aydinli
Background/Aims: Liver transplant is the ultimate and exclusive treatment of liver failure. Since the transfer of hepatic lobe takes place along with its own hepatic artery, the anastomosis process requires the utilization of microsurgical techniques and equipment in the living donor liver transplantations (LDLT). The success of the anastomosis directly affects the result of the surgery and thereby effects patient survival. Otherwise, in the case of failure, it can lead to mortality of the patient. The aim of this study is to retrospectively evaluate the hepatic artery anastomosis in terms of vascular characteristics, arterial diameters, operation time, complications, and thrombosis rates and also to achieve more successful results with lower complication rates. Furthermore, the study aims to share the accumulated knowledge and the experience to develop the technique further and to learn how to make the transfer more easily in the future. Materials and Methods: From 2010 to 2017, 85 LDLTs were performed in Ataturk University Organ Transplantation and Research Center. The hepatic artery anastomosis was performed by the same microsurgeon. Results: We have not encountered any hepatic arterial thrombosis. The success of 100% anastomosis in our series is compatible with the literature, and it was found to have a higher success rate. However, the fact that our current series is small should not be overlooked. Conclusion: The collaboration between microsurgeons and transplant surgeons to reduce technical complications can play an important role in obtaining long-term and permanent transplantation outcomes.
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Peroneal pedicle: An underutilized recipient vessel p. 146
Hardeep Singh, Ankit Jain, Sanjay Mahendru, Rakesh Kumar Khazanchi
Introduction: Anterior and Posterior tibial vessels are commonly used for anastomosis in lower limb reconstruction. There are situations when both of these vessels have inadequate flow or the lie of the adjacent vessel in relation to the flap is not conducive for total coverage of the defect. In these situations, Peroneal pedicle can be used as the recipient vessel for free tissue transfer. We present our experience of using Peroneal pedicle as recipient vessel for successful free tissue transfer. Methods: All the patients undergoing free tissue transfer for lower limb reconstruction having anastomosis with Peroneal vessels were included. The patients fall under two groups. 1. Trauma- 6 patients with complex defect due to trauma had normal palpable distal pulsations at ankle but the target vessel was thrombosed, flap orientation was not conducive for the other vessel hence intraoperative decision to use Peroneal vessels was made. 2. Diabetic foot- Three patients had clinically non palpable pulsations at the ankle. They had biphasic flow in both the Tibial vessels and triphasic in peroneal as confirmed preoperatively with color Doppler. Free flaps were done using the anastomosis to Peroneal vessels. Results: Of 182 free flaps for lower limb reconstruction in last 4 years we have used Peroneal vessels as recipient pedicle in nine patients for successful free tissue transfer. All the flaps survived without any complication. Conclusion: Peroneal pedicle can be safely utilized as recipient vessel for free to free transfer in special situations. This is an underutilized pedicle to reconstruct many complex defects.
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Repair of large soft-tissue finger defects with super-thin mobile abdominal flap at thickness of finger skin p. 152
Ayhan Okumus
Background: The repair of soft-tissue defects on fingers usually utilize hand and finger flaps near the defect area. Regional flaps are insufficient for multifinger defects or defects larger than 5 cm, while pedicle flaps produce esthetically and functionally unsatisfactory outcomes due to the thickness of the donor tissue. This study investigates the use of abdominal flaps prepared to match the thickness of finger skin. Material and Methods: A total of 12 fingers (six patients: 3M, 3F, average age: 27), all with soft-tissue defects, that required local flap surgery but for which adjacent local flaps were not sufficient, were included in this study. Random glove-like mobile abdominal flaps prepared from the inguinal region, were applied in similar thinness to the defect skin on all fingers. Results: Cases were followed postoperatively for an average of 7 years. Flap necrosis was not encountered in any patient, and no patients required additional surgery. esthetically and functionally, satisfactory results were obtained by treating large finger defects caused by injuries using this method. Conclusion: We demonstrated that a mobile flap harvested at the thickness of finger skin can be adapted to the finger in such a way that the finger can remain completely outside. This method is favorable and reliable in situations where local flaps are inadequate, such as in the treatment of finger wounds with large defects, multiple finger injuries necessitating circumferential style repairs or where distant and free flaps would lead to esthetic and functional problems.
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Percutaneous needle aponeurotomy and fat injection for the treatment of dupuytren's contracture p. 159
Ali Riza Oreroglu, Tolga Aksan, Muhammed Besir Ozturk, Ilker Uscetin, Suzan Deniz Onol, Mithat Akan, Necmettin Kutlu
Background: Among the various procedures that have been used to treat Dupuytren's contracture, percutaneous needle aponeurotomy (PNA) is a popular technique with the disadvantage of a high recurrence rate. The purpose of this study is to combine PNA with autologous fat grafting to correct the contracture, return the palmar surface to its normal appearance and feel, and reduce recurrence. Patients and Methods: Thirty-three patients were operated of whom thirty were successfully followed up for 1 year. Forty-two rays were operated on all patients undergoing magnetic resonance (MR) imaging before and after the surgery. All patients had the contracture released by the way of PNA followed by fat grafting. Results: Hand examination revealed a smooth, painless, and soft skin, with an overall improvement rate of 90.1% 1 year postsurgery, presenting a recurrence rate of 18.6% that is significantly lower when compared to other studies performing PNA alone. MR evaluation showed regression in the pathologic cords and stability in the volume of the fat grafts. A minor complication rate of 23.9% and a major complication rate of 6.5% specific for PNA were observed. Conclusion: PNA is a minimally invasive technique that can be used for the treatment of contractures in almost all stages of Dupuytren's disease. Autologous fat grafting can be useful in offering the subcutaneous tissue a soft appearance and feel and preventing recurrence by filling in the potential space by fat instead of fibrosis, preventing expansion of the local mesenchymal progenitor cells responsible for the disease.
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Use of propeller flaps for reconstruction of extensor side elbow defects p. 166
Daghan Dagdelen, Alper Aksoy
Introduction: Extensor side elbow defects are difficult to repair among upper extremity injuries. The bulk of surrounding soft tissue is limited and often affected by the trauma, although seems to be ideal, propeller flaps are not being widely adopted for upper extremity soft-tissue reconstructions. In the present study, we set out to share the results of the perforator propeller flaps that are based on either the arm or the forearm, which we thought the perforator vessel anatomy is relatively constant. Patients and Methods: All patients who underwent elbow defect repair between June 2016 and June 2018 were evaluated retrospectively. Patients were evaluated in terms of the etiology and demographic parameters. Flaps were assessed by the artery system, on which they were based on the dimensions of skin island, the rotation angle of the skin paddle, and closure method of the donor site. Outcomes were noted during bimonthly follow-up visits. Results: In 11 patients, the dominant etiology was chronic bursitis. The mean flap skin paddle size was 48.8 ± 16.9 cm2. For defect repair, radial collateral artery (RCA) perforator flaps were used in six patients. Posterior interosseous artery (PIA) perforator flaps were used in remaining five patients. All the flaps were based on a single perforator artery. The mean rotation degree was measured as 165° ±11.6°. In nine cases, the flap donor site was closed primarily, whereas split-thickness skin grafts were used in two cases. The average follow-up period was 13 ± 5 months. No limitation in the range of motion of the elbow joint was noted. Distal marginal necrosis was observed in two flaps. Conclusion: We advocate that both PIA and RCA perforator flaps are very useful options for soft-tissue reconstruction of extensor side elbow defects.
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What is the role of hand surgery in plastic surgery? Analysis of hand surgery papers presented in Turkish national congresses of plastic, reconstructive, and aesthetic surgery p. 171
Gokce Yildiran, Mustafa Sutcu, Erden Erkut Erkol, Osman Akdag
Context: Scientific studies are often presented primarily to a group of colleagues at annual scientific meetings. All year rounds are turned into products in congresses. Aims: The aim of the study is to evaluate the extent of the hand surgery in plastic surgery and plastic surgeons' papers related with hand surgery in national congresses; the past eight plastic surgery congresses were classified and presented. Settings and Design: The abstract books of Turkish National Congresses of Plastic, Reconstructive, and Aesthetic Surgery between 2011 and 2018 have been evaluated retrospectively. Subjects and Methods: Distribution of hand surgery according to the topics was evaluated according to the European White Book rules and standards. Distribution of oral and posters and distribution by years were shown. Results: The ratio of hand surgery reports to all reports was 17.3%. Hand and upper extremity surgery topics were presented at 19.7% in the 38th congress, which is the most hand surgery-included congress. The most frequently presented subjects were tumors, flaps, trauma, congenital anomalies, and replantation. Conclusions: Although there are arguments that plastic surgeons have disregarded hand surgery, there is no similar situation for Turkish plastic surgeons in the national platform. It has been found that the most common topics such as tumor excision and repair of the tissue defect were the most presented issues rather than arthroscopy, paralytic hand, and arthritis, which are specific to the hand surgery. Increasing the number of plastic surgery specialists who have been trained with hand surgery as a subspecialty will bring up the subjects that have not been presented in the hand surgery so far, in the future congresses.
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Novel mutations with clinical variability and surgical experience in van der woude syndrome p. 176
Ahmet Cevdet Ceylan, Figen Ozgur, Ibrahim Vargel
Introduction: Van der Woude syndrome (VWS) is characterized by cleft palate, cleft lip, and lower-lip pits. Interferon regulatory factor 6 (IRF6) gene mutations have been reported as the cause of VWS. Subjects and Methods: Full stories of the affected individuals were obtained, and a pedigree analysis that goes back three-generation pedigree was performed. The IRF6 gene Sanger sequence analysis was performed on 43 affected individuals with ages ranging between 1 month and 84 years. Results: Our report comprises the molecular diagnosis of 43 patients with VWS in six different families. The c.841-2A>C mutation and the c.881T>A mutation are novel and have not been reported before. These novel mutations affect exon 7 of the IRF6 gene. Conclusion: The c.841-2A>C mutation is a splice site mutation, which is less common in the IRF6 gene and helps us understand the genomic structure better. A novel c.881T>A mutation was identified in exon 7. Due to variable expression, the same mutation can present itself in different clinical manifestations. However, different mutations in the same gene can also be observed through different phenotypes. Therefore, the clinical manifestations of new mutations can lead us to a better understanding of the causes of the disease. In addition, knowing the molecular cause of the disease is also useful for the surgical interventions.
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A style guide for scientific writing p. 180
Kemal Taskiran
This style guide used by Kemal TAŞKIRAN, the author of the guide, for the translation of scientific manuscripts in Turkish into English includes rules compiled from several manuals, books and websites indicated below under references.
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A rare cause of unclosed abdominal wall wound: Swallowed suture needles p. 185
Percin Karakol, Burak Ergun Tatar, Can Uslu, Melihcan Sezgic
Foreign body ingestion that is mostly seen in children, may also seen in adults with psychiatric disorders. Many foreign bodies are excreted with feces; otherwise, they may perforate abdominal organs and cause peritonitis. Sometimes, they can migrate organs and penetrate the abdominal wall. We report, in this report, a 33-year-old unemployed tailor woman with her sister with Munchausen syndrome by proxy disorder. The patient has an unclosed wound after having swallowed multiple suture needles in attempt of suicide. Foreign body ingestion may present with various symptoms. Abdominal nonhealing wounds can occur, and after several attempts of treatment, if there are recurrent dehiscence, psychiatric disorders should be considered.
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A “Grey Swan” malignant melanoma: Implantation metastasis on the skin graft donor site p. 188
Ibrahim Tabakan, Ahmet Umut Yuvaci, Eyuphan Gencel, Arbil Acikalin
We report a 67-year-old male presented with recently evolved malignant melanoma (MM). This MM was interestingly located on the split-thickness skin graft donor site which was harvested 3 months ago for repairing previous frontoparietal MM excision area. This case was presented and literature was reviewed.
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Basosquamous cell carcinoma bone metastasis on coracoid process p. 192
Yuksel Ugur Yaradilmis, Fatih Tekin, Ismail Demirkale, Furkan Erol Karapekmez
Although basal cell carcinoma (BCC) is the most commonly encountered skin carcinoma, metastasis rarely develops. Fewer than 300 cases of metastasis due to BCC have been presented in the literature. The coracoid process is a small area, and metastases are rarely seen in this bone localization. The case here presented is a 56-year-old male with coracoid process metastasis as a distant metastasis of basosquamous cell carcinoma (BSC) located in the face. This locally aggressive lesion due to BSC had been treated surgically five times by the plastic surgeon and was consulted by our clinic with the positron emission tomography-computed tomography report in respect of coracoid process involvement. A clean surgical margin was obtained with excision of the coracoid process. The conjoint tendon was fixed again with an anchor suture to the base of the coracoid, from which the tumor had been cleaned. The constant shoulder score was determined as 100 points after surgery.
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Sacrifice feast disease: Orf p. 195
Burak Ozkan, Cagri A Uysal, Halit Uner, Nilgun M Ertas
Orf disease is a zoonotic infectious caused by parapox virus transmitted by contaminated meat that entered from the disrupted skin. It is usually seen in butchers, farmers, or people who have contact with meat of infected animals commonly in sacrifice feast in Muslim countries. Two patients who admitted to our clinic with orf disease after sacrifice feast were presented. Orf disease should be considered, especially in sacrifice feast term in our country. It heals uneventfully and unnecessary manipulations should be avoided.
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Erratum: Measurement of epidermis, dermis, and total skin thicknesses from six different body regions with a new ethical histometric technique p. 198

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